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APLS > Child with breathing difficulties > Flashcards

Child with breathing difficulties Flashcards

1
Q

The thoracic cage of children is more compliant than that of adults. T or F?

What are the implications of this when there is airway obstruction?

A

True.

Increased compliance results in marked chest wall recession and a reduction in the efficacy of breathing

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2
Q

Mechanisms causing upper airway obstruction in children?

A

Epiglottitis / croup

Foreign body

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3
Q

Mechanisms causing lower airway obstruction in children?

A

Bronchiolitis
Asthma
Tracheitis

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4
Q

Disorders around the lungs that cause breathing difficulties in children?

A

Pneumothorax
Pleural effusion or empyema
Rib fractures

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5
Q

Disorders affecting the lungs that cause breathing difficulties in children?

A

Pneumonia

Pulmonary oedema

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6
Q

Disorders below the diaphragm that cause breathing difficulties in children?

A

Abdominal distension

Peritionitis

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7
Q

Disorders that cause increased respiratory drive in children?

A

DKA
Shock
Poisoning e.g. salicylates
Anxiety / hyperventilation

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8
Q

Disorders that causes decreased respiratory drive in children?

A

Coma
Convulsions
Increased ICP
Poisoning

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9
Q

With regards to lung volumes, why are infants more at risk of small airway closure and hypoxia?

A

The lung volume at end expiration is similar to the closing volume in infants

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10
Q

What is the significance of the large presence of fetal haemoglobin in the first few months of life?

A

It shifts the oxygen dissociation curve to the left
Means oxygen gives off less readily to the tissues
So more prone to hypoxia and acidosis

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11
Q

Clinical features that suggest cardiac cause of respiratory inadequacy?

A 
Cyanosis not correcting with O2 therapy 
Tachycardiac out of proportion to resp difficulty 
Raised JVP 
Gallop rhythm/murmur 
Enlarged liver
Absent femoral pulses
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12
Q

Commonest pathogen causing croup

A

Parainfluenza

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13
Q

Presentation of croup

A

barking cough
harsh stridor
hoarseness

preceded by fever + coryza for 1-3 days

symps often worse at night

as obstruction progresses:

  • sternal & subcostal recession
  • tachycardia
  • tahcypnoea
  • hypoxia
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14
Q

Commonest age group for croup

A

6 months - 5 years

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15
Q

Rx of croup

A

oral dexamethasone 150 mcg/kg or pred 0.5-1 mg/kg

or

inhaled budesonide (if not taking oral meds or vomiting)

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16
Q

Which children require emergency Rx of croup and what is the emergency Rx

A

Children in severe respiratory distress with harsh stridor and barking cough

Nebulised adrenaline 400 mcg/kg of 1:1000 with O2 with face mask
+
Oral steroids (dex or pred)

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17
Q

Clinical signs in croup that suggest intubation is required

A 
increasing tachycardia 
tachypnoea 
chest retraction 
cyanosis 
exhaustion 
confusion
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18
Q

A foreign body in the trachea tends to lie in which plane on CXR?

A

sagittal

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19
Q

A foreign body in the oesophagus tends to lie in which plane on CXR?

A

anterior

20
Q

What % of foreign body inhalations have a normal CXR?

A

20%

21
Q

Rx of foreign body inhalation?

A

If stable - remove the foreign body under controlled conditions - removal via bronchoscope under GA

If extreme life threatening case - direct laryngoscopy and removal with Magills forceps

22
Q

Most common causative pathogen of epiglottitis

A

Haemophilus influenza B

23
Q

Presentation of epiglottitis

A 
Fever 
Lerthargy 
Soft inspiratory stridor 
Rapidly increasing respiratory difficulty over 3-6 hours 
Minimal or absent cough 
Drooling 
Pale/toxic appearance
24
Q

Important movements NOT to do with children with suspected epiglottitis

A

Lie them down or open mouth to examine airway

25
Q

Mx epiglottitis

A 
Senior input ENT/anaesthetics 
Deeply anaesthetise - only lie flat after to intubate 
Secure airway 
Blood for culture 
IV cefotaxime or ceftriaxone

Most only need intubated for 24-36 hours and fully recover in 3-5 days.

26
Q

Most common causative pathogen of bacterial tracheitis

A

staph aureus,
streptococci or
Hib

27
Q

Presentation of bacterial tracheitis

A 
Harsh cough 
Purulent secretions 
Toxic appearance
Fever 
Signs of progressive upper airway obstruction
28
Q

Rx of bacterial tracheitis

A 
Intubation and ventilatory support 
IV Abx (cefotaxime or ceftriaxone + flucloxacillin)
29
Q

Pathophysiology of bacterial tracheitis

A

aka pseudomembranous croup
life threatening form of upper airway obstruction

infection of the tracheal mucosa, resulting in copious, purulent secretions and mucosal necrosis

30
Q

2 commonest causes of lower respiratory obstruction in children

A

Acute severe asthma or episodic viral wheeze (> 1 year olds)

or

Bronchiolitis (<1 year olds)

31
Q

Signs of acute severe asthma

A 
Too breathless to feed or talk 
High RR (>30 in over 5's or >50 in 2-5's) 
High HR (>120 in over 5's or >130 in 2-5's)
32
Q

Signs of life threatening asthma

A 
Exhaustion 
Poor respiratory effort 
Silent chest 
Hypotension 
Reduced conscious level
33
Q

Criteria for ‘mild’ exacerbation of asthma

A

Sats > 92% AND

No incr WOB or accessory muscle use
No incr in HR or RR
Normal mental state
Able to talk normally

34
Q

Criteria for ‘moderate’ exacerbation of asthma

A

Sats >92% AND

Moderate incr WOB - chest recession/accessory muscle use
Dyspnoea resulting in shortened sentences
Normal mental state
PEWS <2 for both HR and RR

35
Q

Criteria for ‘severe’ exacerbation of asthma

A

Sats <92% AND

Agitated and distressed
Marked dyspnoea 
Severe incr WOB 
Marked accessory muscle use
HR and RR PEWS >2
36
Q

Rx for mild asthma

A

10 puffs salbutamol via spacer
Assess response after 10 min
Consider oral pred

37
Q

Rx for moderate asthma

A

10 puffs salbutamol x3 over 1 hour
+
Oral pred

Then assess response after 10 min

If no response move to severe pathway

If responding, stretch MDI dosing as able

38
Q

Rx for severe asthma

A

‘mega neb’ x3 over 1 hour

  • salbutamol
  • ipratropium
  • Mag sulphate
39
Q

Rx of asthma if not improving after 3x meganebs

A

PICU support
IV salbutamol, mag sulf
Loading dose of IV aminophylline (if not on oral theophylline) with ondansetron cover

40
Q

Most common causative pathogen of bronchiolitis

A

RSV

41
Q

Clinical presentation of bronchiolitis

A

fever
nasal discharge

then

dry cough
increasing breathlessness
wheeze +/- crackles
feeding difficulties

42
Q

Risk factors for increased severity of bronchiolitis

A 
Age < 6 weeks 
premature birth 
chronic lung disease
congenital heart disease 
immunodeficiency
43
Q

Bronchiolitis emergency Rx

A

Mainly supportive - fluid replacement, gentle suctioning of nasal secretions, prone position, O2 therapy + resp support if required

ABC first (!)

44
Q

How long do symps of bronchiolitis normally last for

A

3-7 days

45
Q

Main causes of heart failure in 1. infants, 2. older chidlren

A
  1. structural heart disease, congenital heart defects

2. myocarditis, cardiomyopathy

APLS (4 decks)

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